- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,068.11 / $1,068.11 / $6,180.88
| Professional | | $1,068.11 | $1,068.11 | $6,180.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,952.65 / $9,144.62 / $17,688.66
| Facility | | $6,952.65 | $9,144.62 | $17,688.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.14 / $1,762.73 / $2,350.30
| Professional | | $1,034.14 | $1,762.73 | $2,350.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,757.00 / $2,639.59 / $3,535.20
| Professional | | $1,757.00 | $2,639.59 | $3,535.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.11 / $1,869.21 / $7,276.78
| Facility | | $1,068.11 | $1,869.21 | $7,276.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,457.16 / $2,401.46 / $3,282.41
| Professional | | $1,457.16 | $2,401.46 | $3,282.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $2,542.44 / $3,535.20
| Facility | | $1,285.00 | $2,542.44 | $3,535.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,939.12 / $2,412.77 / $3,535.20
| Professional | | $1,939.12 | $2,412.77 | $3,535.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,457.16 / $2,390.44 / $3,129.06
| Professional | | $1,457.16 | $2,390.44 | $3,129.06 |